health care

1. healthcare
Article
The Top 100 Most Cited Articles Published in Dentistry:
2020 Update
Faris Yahya Asiri 1,*, Estie Kruger 2 and Marc Tennant 2
Citation: Asiri, F.Y.; Kruger, E.;
Tennant, M. The Top 100 Most Cited
Articles Published in Dentistry: 2020
Update. Healthcare 2021, 9, 356.
https://doi.org/10.3390/
healthcare9030356
Academic Editor: Takahiro Kanno
Received: 30 January 2021
Accepted: 26 February 2021
Published: 21 March 2021
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4.0/).
1 Department of Preventive Dentistry, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabia
2 International Research Collaboration—Oral Health and Equity, School of Human Sciences, Faculty of Science,
The University of Western Australia, Perth, WA 6009, Australia; estie.kruger@uwa.edu.au (E.K.);
marc.tennant@uwa.edu.au (M.T.)
* Correspondence: fasiri@kfu.edu.sa; Tel.: +966-567-727779
Abstract: This bibliometric review is aimed to analyze the top 100 most-cited publications in dentistry
and to compare its outcomes. A literature search was performed using Elsevier’s Scopus, without
any restriction of language, publication year, or study design. Of 336,381 articles, the top 100 were
included based on their citation count, which ranged from 638 to 4728 citations (Feijoo et al., 326 to
2050). The most productive decade was the 2000s, with 40 articles on the list (Feijoo et al., 1980s: 26).
Marx RE (7%) was the major contributor in this study (Feijoo et al., Socransky SS: 9%), and almost
half (48%) of articles were from the USA. Of the top 100 articles, 26% focused on periodontology
(Feijoo et al., periodontology: 43%), while 17% of the total were published in the Journal of Dental
Research (Feijoo et al., Journal of Clinical Periodontology: 20%). Most of the publications were
narrative reviews/expert opinion (36%), (Feijoo et al., case series: 22%), and were within the evidence
level V (64%) (Feijoo et al., 54%). The citation count that a paper secures is not necessarily a reflection
of research’s quality, however, the current analysis provides the latest citation trends in dentistry.
Keywords: bibliometric analysis; citation analysis; dentistry; most cited
1. Introduction
As a science, dentistry has reached a high maturity level in recent decades [1]. In
academia, journals play a crucial role by disseminating technical and scholarly work, peer-
review and evaluating research, archiving such research, and providing a foundation for
scholarly credits [2]. In 2004, Olk and Griffith stated that journals serve as the primary
source of knowledge in a particular specialty. They argued that the boundaries of a given
discipline are pushed by scholars, however, journals are essential to advance the main body
of knowledge [3]. The American Journal of Dental Science, the world’s first dental journal,
began its publication in 1839 [4]. Since then, journals in dentistry have been performing
as a mode of communication and source of knowledge within the dental community and
other related fields. Hence, valid and reliable tools are necessary to analyze and document
several changes that may occur in the lifetime of a single academic journal or group of
journals [2].
Citations are potential indicators of a publication’s impact in this expanding scientific
literary environment [5]. A citation is an alphanumeric expression that acknowledges a
particular subject’s contribution to others’ research [6,7]. Citation analysis is a bibliometric
method to identify articles with the greatest impact on research and the clinical community
in a given discipline [8], providing the foundation for developing new research lines,
techniques, and theories. This method has been adopted in different dentistry subfields
including endodontics, orthodontics, periodontology, implant dentistry, prosthodontics,
oral and maxillofacial surgery, dental traumatology, dental caries, oral squamous cell
carcinoma, oral submucous fibrosis, oral leukoplakia, cleft lip and palate, and medication-
related osteonecrosis of the jaw (MRONJ) [9–22]. The definition of “classic article” has been
Healthcare 2021, 9, 356. https://doi.org/10.3390/healthcare9030356 https://www.mdpi.com/journal/healthcare

2. Healthcare 2021, 9, 356 2 of 15
a controversial topic across disciplines, and the most commonly suggested criterion has
been the securing of a certain citation count, for instance, at least 400 citations [8,23,24].
However, a publication having accomplished 100 or more citations can also be termed as a
“classic publication,” depending upon the field under consideration, such as dentistry [25].
This bibliometric review aimed to identify and analyze the scientific activity of dental
sciences up to 2020. The Elsevier’s Scopus database was utilized to accomplish three
specific objectives: (a) characterize the dental research in association with output, impact,
geographic origin, authorship, topic, methodology design, and evidence level; (b) themat-
ically categorizing research in dental areas, analyzing their interactions and evaluating
their up-to-date trends; (c) assess any changes in citation trends of dentistry articles when
compared with a similar, but much earlier study, published by Feijoo et al. [9] in 2014.
2. Results
2.1. Citation Count, Citation Density, and Current Citation Index
The primary characteristics of the top 100 most-cited articles in dentistry are shown
in Supplementary Table S1. Overall, the 100 most-cited articles published in dentistry
journals achieved a total of 113,482 (Scopus) and 214,642 (Google Scholar) citations; with
the citation count varying between 638 and 4728 (Scopus), and 138 and 8281 (Google
Scholar). According to Scopus, 33 articles exceeded 1000 citations; with 33 articles securing
more than 2000 citations as per Google Scholar. The most cited article, with a total of 4728
(Scopus), 8281 (Google Scholar) citations, was as a clinical trial titled “Periodontal Disease
in Pregnancy II. Correlation between Oral Hygiene and Periodontal Condition” [26], and
was published in the Acta Odontologica Scandinavica. Its citation density was 84, with the
current citation index of 269. The second most cited article, with a total of 4062 (Scopus),
7873 (Google Scholar) citations, was similar to the first article, but was published one year
earlier titled “Periodontal disease in pregnancy I. Prevalence and severity” [27], and was
also published in the Acta Odontologica Scandinavica. Its citation density was 71, with the
current citation index of 232. The third most cited article, with a total of 3392 (Scopus), 6257
(Google Scholar) citations, was also a clinical trial titled “A 15-year study of osseointegrated
implants in the treatment of the edentulous jaw” [28] and was published in the International
Journal of Oral and Maxillofacial Surgery. Its citation density was 117, with the current
citation index of 96.
As per citation density, a review by Guo and DiPietro [29] has the highest score, i.e.,
186. In the second rank, with a citation density of 181, is an article related to the category of
classification or tools for assessing results [30]. The third-ranked article (citation density
of 167) is a position paper by Ruggiero et al. [31]. According to the current citation index
2020, the top-ranked article was a review published in 2010, securing 345 citations [29]. The
second-ranked article was a recommendation paper related to the category of classification
or tools for assessing results written by Schiffman et al. [30] in 2014, with 299 citations. The
third-ranked article was a clinical trial by Sillness and Löe, which counted 269 citations [26].
According to the Shapiro–Wilk test, the distribution of data regarding citation count,
citation density, and article age was not normal (p 0.01). A significant trend towards
a higher citation count with article age was observed (r = 0.832, p 0.01) (Figure 1A).
However, a non-significant trend towards an increased citation density with the age of
publication was observed (r = 0.176, p = 0.129) (Figure 1B).
2.2. Distribution by Year
The top 100 most-cited articles were published between 1955 [32] and 2014 [30,31].
The most prolific year in terms of publications was 2004, with seven publications, followed
by 1997, 1998, 2003, and 2007 with five articles each. The year with most citations was 1998,
with 6829 citations, followed by 2004 and 2003, with 6190 and 5879 citations, differently. The
decade with most publications (n = 40) and citations (n = 35,743) was the 2000s (Figure 2A).

3. Healthcare 2021, 9, 356 3 of 15
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Figure 1. Association of (A) citation count and (B) citation density with the age of publication. The
dot represents individual publication and line represents trendline.
2.2. Distribution by Year
The top 100 most-cited articles were published between 1955 [32] and 2014 [30,31].
The most prolific year in terms of publications was 2004, with seven publications, fol-
lowed by 1997, 1998, 2003, and 2007 with five articles each. The year with most citations
was 1998, with 6829 citations, followed by 2004 and 2003, with 6190 and 5879 citations,
differently. The decade with most publications (n = 40) and citations (n = 35,743) was the
2000s (Figure 2A).
Figure 1. Association of (A) citation count and (B) citation density with the age of publication. The
dot represents individual publication and line represents trendline.
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Figure 2. (A) Citation analysis of the top 100 most-cited articles over the decades. (B) The contribu-
tion of countries to the top 100 articles.
2.3. Contribution of Countries
The top 100 most-cited publications originated from 15 countries, including Aus-
tralia, Belgium, Brazil, Canada, Denmark, Finland, France, Germany, Italy, Netherlands,
Norway, Sweden, Switzerland, the United Kingdom (UK), and the United States of Amer-
ica (USA) (Figures 2B and 3A). According to the number of publications, most of the arti-
cles originated from the United States of America (n = 48), followed by Sweden (n = 14),
Figure 2. (A) Citation analysis of the top 100 most-cited articles over the decades. (B) The contribution
of countries to the top 100 articles.

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2.3. Contribution of Countries
The top 100 most-cited publications originated from 15 countries, including Australia,
Belgium, Brazil, Canada, Denmark, Finland, France, Germany, Italy, Netherlands, Norway,
Sweden, Switzerland, the United Kingdom (UK), and the United States of America (USA)
(Figures 2B and 3A). According to the number of publications, most of the articles originated
from the United States of America (n = 48), followed by Sweden (n = 14), Belgium (n = 6),
Switzerland (n = 6), UK (n = 5), Denmark (n = 4), Canada (n = 3), Finland (n = 2), France
(n = 2), Germany (n = 2), Italy (n = 2), Netherlands (n = 2), Norway (n = 2), Australia (n = 1),
and Brazil (n = 1).
2.4. Contribution of Authors
A total of 264 authors contributed to the top 100 most-cited articles. Many of the
articles (n = 84) had between one and six authors, but publications with two authors were
the most common (n = 27). The majority of the contributions were made by Marx RE
(n = 7, 8230 citations), followed by Löe H (n = 4, 12,668), Lekholm U (n = 4, 6654), Haffajee
AD (n = 4, 5313), Socransky SS (n = 4, 4843), Albrektsson T (n = 4, 4658), De Munck J (n = 4,
3772), and Genco RJ (n = 4, 3014) (Table 1 and Figure 3B).
Table 1. Contribution of authors to the top 100 most-cited articles in dentistry.
Author Name * Number of Articles Citation Count
Marx RE 7 8230
Löe H 4 12,668
Lekholm U 4 6654
Haffajee AD 4 5313
Socransky SS 4 4843
Albrektsson T 4 4658
De Munck J 4 3772
Genco RJ 4 3014
Brånemark PI 3 6140
Mehrotra B 3 3183
Ruggiero SL 3 3183
Lambrechts P 3 3156
Van Landuyt K 3 3049
Van Meerbeek B 3 3049
Yoshida Y 3 2620
Sjögren U 3 2444
Sundqvist G 3 2444
Lindhe J 3 2439
Zambon JJ 3 2144
Berglundh T 3 2112
* Due to a high number of contributing authors to the top 100 most-cited articles, it was not possible to mention
all the authors in a table. Hence, the authors who contributed to ≥3 articles were included in the table.
2.5. Journal of Publication
Overall, the top 100 most-cited articles in dentistry were published in both specialized
and comprehensive periodicals (n = 31) (Table 2 and Figure 3C). The journal with the
greatest number of publications was the Journal of Dental Research (n = 17, 17,836 citations),
followed by Journal of Periodontology (n = 11, 12,141), Journal of Clinical Periodontology (n = 9,
8461), Journal of Oral and Maxillofacial Surgery (n = 8, 8873), Dental Materials (n = 7, 6220),
Journal of Endodontics (n = 5, 3927), and Periodontology 2000 (n = 4, 3391).

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Table 2. List of journals in which the top 100 most-cited articles were published.
Journal Name JIF (2019) * 5-Year JIF *
No. of
Articles
Citation Count
J Dent Res 4.914 5.844 17 17,836
J Periodontol 3.742 3.614 11 12,141
J Clin Periodontol 5.241 5.213 9 8461
J Oral Maxillofac Surg 1.642 2.020 8 8873
Dent Mater 4.495 5.386 7 6220
J Endod 3.118 3.380 5 3927
Periodontol 2000 7.718 8.888 4 3391
Int J Oral Maxillofac Surg 2.068 2.987 3 4200
Oral Surg Oral Med Oral Pathol Radiol 1.601 1.810 3 3345
J Prosthet Dent 2.444 2.727 3 2915
Acta Odontol Scand 1.573 1.785 2 8549
Int J Oral Maxillofac Implants 2.320 2.987 2 3996
Commun Dent Oral Epidemiol 2.135 2.558 2 2310
J Oral Pathol Med 2.495 2.330 2 2166
Commun Dent Health 0.679 1.140 2 2064
J Am Dent Assoc 2.803 2.950 2 1816
Am J Orthod Dentofac Orthop 1.960 2.405 2 1814
Clinical Oral Implants Research 3.723 4.044 2 1723
Eur J Oral Sci 2.220 2.225 2 1667
Int Dent J 2.038 1.863 1 1651
Oral Oncol 3.979 - 1 1585
Oper Dent 2.213 2.954 1 1248
Int J Periodontics Restorative Dent 1.513 1.739 1 968
J Oral Fac Pain Headache 1.260 2.421 1 941
Implant Dent 1.452 1.606 1 781
Arch Oral Biol 1.931 2.112 1 752
J Can Dent Assoc 1.200 0.917 1 735
J Dent 3.242 4.265 1 725
Int Endod J 3.801 3.418 1 721
Int J Prosthod 1.490 1.692 1 678
J Dent Edu 1.322 1.371 1 649
* Journal Citation Report (JCR) 2019. Abbreviation: JIF = Journal impact factor. Source for impact factor:
https://www.jcr.clarivate.com (accessed on 5 January 2021).
Healthcare 2021, 9, x 6 of 17
J Dent 3.242 4.265 1 725
Int Endod J 3.801 3.418 1 721
Int J Prosthod 1.490 1.692 1 678
J Dent Edu 1.322 1.371 1 649
* Journal Citation Report (JCR) 2019. Abbreviation: JIF = Journal impact factor. Source for impact
factor: https://www.jcr.clarivate.com (accessed on 5 January 2021).
Figure 3. (A) Network visualization per author (Elsevier’s Scopus data 1980–2010). (B) Network visualization per count
(Elsevier’s Scopus data 1990–2010). (C) Network visualization per journal (Elsevier’s Scopus data 1990–2010). (D) Network
visualization per author keywords (Elsevier’s Scopus data 1990–2010).
A statistically non-significant trend (p = 0.204) was observed between a journal age
and the number of articles published in that journal. However, a statistically significant
trend (p 0.05) was observed between the impact factor of the journal and the number of
articles published in that journal.
Figure 3. (A) Network visualization per author (Elsevier’s Scopus data 1980–2010). (B) Network visualization per count
(Elsevier’s Scopus data 1990–2010). (C) Network visualization per journal (Elsevier’s Scopus data 1990–2010). (D) Network
visualization per author keywords (Elsevier’s Scopus data 1990–2010).

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A statistically non-significant trend (p = 0.204) was observed between a journal age
and the number of articles published in that journal. However, a statistically significant
trend (p 0.05) was observed between the impact factor of the journal and the number of
articles published in that journal.
2.6. Field of Interest
For the 100 most-cited articles, the field of interest for the majority were related to
Periodontology (n = 26, 32,410 citations), adhesive restorations (n = 14, 11,915), implan-
tology (n = 13, 15,592), oral medicine/pathology (n = 12, 12,785), endodontics (n = 8,
5936), oral hygiene (n = 8, 10,643), bone morphology/histology (n = 7, 6943), oral biol-
ogy/morphology (n = 4, 5862), regenerative dentistry (n = 2, 2228), orthodontics (n = 2,
1814), saliva/biochemistry (n = 1, 917), pain dysfunction/orofacial pain syndrome (n = 1,
941), dental radiology (n = 1, 735), and behavior management (n = 1, 735) (Table 3).
Table 3. Distribution of fields of interest, study designs, and evidence levels of the top 100 most-cited articles.
Variable Publications per Citation Count Median (min-max) p-Value
Field of Interest
Periodontology 26% 32,410 818.5 (638–4728)
p = 0.274
Adhesive Restorations 14% 11,915 724 (638–1560)
Implantology 13% 15,592 838 (649–3341)
Oral Medicine/Pathology 12% 12,785 927.5 (662–1798)
Oral Hygiene 8% 10,643 1157.5 (717–1311)
Endodontics 8% 5936 780 (656–883)
Bone morphology/Histology 7% 6943 845 (692–1813)
Oral Biology/Morphology 4% 5862 1450.5 (756–2517)
Regenerative Dentistry (Stem cells) 2% 2228 1114 (979–1249)
Orthodontics 2% 1814 907 (719–1095)
Pain dysfunction/Orofacial pain syndrome 1% 941 941 (941)
Saliva/Biochemistry 1% 917 917 (917)
Behavior Management 1% 735 735 (735)
Dental Radiology 1% 735 735 (735)
Study Design
Narrative review/Expert opinion 36% 34,628 831.5 (637–2517)
p = 0.145
Clinical trial 24% 34,296 952 (638–4602)
Classification or tool for evaluating results 11% 14,072 1099 (703–2350),
Systematic review/Meta-analysis 9% 6627 713 (664–845)
In vitro study 7% 7561 808 (656–1813)
Animal study 4% 4063 884.5 (831–1463)
New material or technique 4% 3048 741.5 (655–910)
Cohort study 2% 1879 939.5 (883–996)
Letter to editor 1% 1798 1798 (1798)
Consensus report 1% 767 767 (767)
Randomized controlled trial 1% 717 717 (717)
2.7. Methodological Design of the Publication
The most common methodological design in the top 100 publications was literature
review/expert opinion (n = 36, 34,628 citations), followed by clinical trial (n = 24, 34,296),
classification or tool for assessing results (n = 11, 14,072), systematic review/meta-analysis
(n = 9, 6627), in vitro study (n = 7, 7561), animal study (n = 4, 4063), new material or
technique (n = 4, 3048), cohort study (n = 2, 1879), consensus report (n = 1, 767), randomized
controlled trial (n = 1, 717), and letter to editor (n = 1, 1798) (Table 3).
2.8. Evidence Level of Publication
The top 100 most-cited publications could be classified into all evidence levels (Table 3).
Most of the articles were within evidence level V (n = 64, 65,937 citations), followed by

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evidence level IV (n = 24, 34,296), evidence level 1 (n = 9, 6627), evidence level III (n = 2,
1879), and evidence level II (n = 1, 717). Among these evidence levels, the total citation
counts (r = −0.226, p = 0.078) and the citation density (r = 0.082, p = 0.633) did not vary
significantly.
2.9. Author Keywords
A total of 538 keywords were identified from the top 100 most-cited articles (Figure 3D).
The most frequently used keyword was osseointegration (n = 6), followed by dental im-
plants (n = 5), periodontal disease (n = 4), periodontitis (n = 3), review (n = 3), surface
roughness (n = 3), dentin (n = 3), epidemiology (n = 3), and wound healing (n = 3).
2.10. Comparison with the Bibliometric Analysis by Feijoo et al.
Table 4 depicts the main differences between the present study and the bibliometric
analysis performed by Feijoo et al. [9]. In the current study, for screening and identifying the
most-cited articles, the author utilized Scopus as the benchmark database and used Google
Scholar to crossmatch the citation data. On the contrary, Feijoo et al. [9] employed the Web
of Science as the benchmark database only. A total of 10 bibliometric parameters were
evaluated in the current analysis as compared to Feijoo et al. [9] in which 7 bibliometric
variables were assessed. For an unknown reason, the journal Acta Odontologica Scandinavica
was not included in the study by Feijoo et al. [9]. Interestingly, the 1st and 2nd ranked
articles in the present analysis were published in the Acta Odontologica Scandinavica. In the
present analysis, 48 articles present in the study conducted by Feijoo et al. [9], could secure
their position. In the present analysis, an increase of almost two-fold in the total citation
counts of the top 100 most-cited articles (113,482 citations) was observed as compared to
Feijoo et al. [9] (52,635 citations). According to the Web of Science, the range of citation
counts in the present study varied between 3 and 4321, as compared to Feijoo et al. [9]
in which the range was between 326 and 2050. According to the Web of Science, 4 and
35 articles could secure ≥1000 and ≥500 citations respectively, in the study conducted by
Feijoo et al. [9]. However, in the current analysis, 33 and 100 articles secured ≥1000 and
≥500 citations, respectively. The decade with the majority of publications was the 2000s
(40%) in the present analysis as compared to the study by Feijoo et al. [9] in which the 1980s
was the most productive decade in terms of the number of top-cited articles (26%). In the
present study, publications having two authors (27%) were the most common as compared
to the study by Feijoo et al. [9] in which single-author papers (25%) were the most frequent.
The biggest contribution was made by Marx RE (7%) in the current study, as compared to
Feijoo et al. [9] in which Socransky SS made the biggest contribution (9%). The Journal of
Dental Research (17%) was the most prolific in the current analysis, compared to the Journal
of Clinical Periodontology (20%) in the Feijoo et al. study [9]. In both the analyses, articles
related to periodontology were the most cited ones. In terms of study design, narrative
review/expert opinion (36%) was the most commonly cited methodological design in the
current study as compared to an analysis by Feijoo et al. [9] in which case series (22%)
was the most frequently cited study design. In terms of evidence level of the publications,
articles having evidence level V were the most cited in both the studies.

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Table 4. Comparative analysis of the differences between the present study and Feijoo et al. [9].
Feijoo et al. [9] Present Study
Database Employment
Clarivate Analytics’ Web of Science
(Benchmark)
Elsevier’s Scopus (Benchmark)
- Google Scholar
-
Assessed Bibliometric Parameters
7 10
Citation Count
Total citation count:
52,635 (WoS)
-
-
Range of citation count:
326–2050 (WoS)
-
-
Articles with ≥1000 citations: 4
Articles with ≥500 citations: 35
Total citation count:
113,482 (ES)
214,642 (GS)
Range of citation count:
638 and 4728 (ES)
138 and 8281 (GS)
Articles with ≥1000 citations: 33
Articles with ≥500 citations: 100
Authorship
Articles with single author: 25
Articles with two authors: 18
Articles with more than 6 authors: 12
Leading author: Socransky SS (n = 9)
Articles with single author: 20
Articles with two authors: 27
Articles with more than 6 authors: 16
Leading author: Marx RE (n = 7)
Publication Year
Decade with most publications: 1980s (26%) Decade with most publications: 2000s (40%)
Field of Interest
1st = Periodontology (43%)
2nd = Implantology (11%)
3rd = Adhesive restorations (8%)
1st = Periodontology (26%)
2nd = Adhesive restorations (14%)
3rd = Implantology (13%)
Study Design
1st = Cases series (22%)
2nd = Narrative review/expert opinion (19%)
3rd = Classifications or tools for evaluating
results (13%)
1st = Narrative review/expert opinion (36%)
2nd = Clinical trial (24%)
3rd = Classifications or tools for evaluating
results (11%)
Evidence Level
EL V = 54% EL V = 64%
Journal of Publication
Total number of journals: 22 Total number of journals: 32
1st = Journal of Clinical Periodontology (20%)
2nd = Journal of Periodontology (18%)
3rd = Journal of Dental Research (16%)
1st = Journal of Dental Research (17%)
2nd = Journal of Periodontology (11%)
3rd = Journal of Clinical Periodontology (9%)
Abbreviation: EL V = evidence level Five; ES = Elsevier’s Scopus; GS = Google Scholar; WoS = Web of Science.
3. Discussion
Authors’ bibliometric analysis allows readers to gain historical insight and develop-
ment of a particular specialty by identifying and analyzing the most-cited publications
that could assist researchers in understanding the emerging themes and future trends for a
particular discipline [33–35]. For instance, the number of citations a publication receives
could indicate other researchers’ interest in using the information for their research. Highly
cited articles could display a tendency in clinical practice and may therefore be considered
to produce greater research and clinical interest in the reported disciplines [36]. Being
“most-cited” article reflects its more frequent contribution to the studies published after-
ward; however, this characteristic alone does not provide sufficient information regarding
its current impact and scientific quality, as the main motive of citers in the selection of
reference is in establishing the utility within research, rather than scientific quality [37–39].
As per the definition of a “classic article”, all the articles included in this study are called
“classic articles” [8,22,23].

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The accuracy of bibliometric analyses might be negatively influenced by the limita-
tions of the search engine used. Elsevier’s Scopus, Google Scholar, and Clarivate Analytics’
Web of Science may differ quantitatively or qualitatively concerning the citation count
of a publication depending upon the discipline of the study [12,16,40], journals [41], and
years [42] in which they were published. Additionally, some publications might not be
available in all of these search engines [16,25,43,44]. There were several reasons for not
selecting either Google Scholar or Web of Science databases as the benchmark for this
analysis. For instance, Google Scholar includes citations from non-scholarly publications in-
cluding dissertations and thesis, conference papers, technical reports, books, and preprints,
which may affect the analysis of the most-cited articles when the target is more specific, as
in the present study [44]. However, in Web of Science, missing references are a considerable
issue [40], which is a likely reason why Buonocore’s highly cited paper [32] in Google
Scholar (4367 citations) and Scopus (1560 citations) was so under cited in Web of Science
(427 citations). Similarly, Löe’s [45] highly cited article in Google Scholar (4019 citations)
and Scopus (2257 citations) received only 3 citations in Web of Science. It is important
to note that both the abovementioned articles were present in the Web of Science “All
Databases” section, and not in the Web of Science “Core Collection”. One of the several
reasons for selecting Scopus as the benchmark database was that it combines the features
of PubMed and Web of Science. These combined characteristics enable improved utility for
medical literature research and academic requirements (i.e., citation analysis) [43]. More-
over, Scopus is regarded as the largest citation and abstract search engine of peer-reviewed
literature. It is devised to aid researchers in not only accessing scientific information but
screening literature for analysis [46], and it has been employed in numerous published
bibliometric analyses [25,47,48]. In Scopus, citation analysis is faster and includes more
publications than that of Web of Science [49]. In a recently performed study for evaluating
the accuracy of citation information in Web of Science and Scopus databases, the authors
stated that the former database includes 16.7% incorrect references, also called phantom
references, 26.7% error in references (i.e., incorrect volume number or publication year),
and 55% missing references [44]. Overall, the author thought Scopus to be the better tool
for this study as compared to the similar study by Feijoo et al. [9] that employed Web of
Science as the benchmark database.
In many bibliometric studies, it was reported that relevant studies were distributed
among journals following Bradford’s law [49–51]. According to this bibliometric law, a
few prolific journals account for a considerable percentage of all publications in a given
discipline [52]. The studies published in these core journals are more probable to be
referred to most commonly by successive articles [53]. Interestingly, in this study, the
journal distribution pattern of the most-cited publications does not completely fit this
law, as the list also features journals such as the Acta Odontologica Scandinavica and the
Journal of Dental Research, which are not considered as the specialized journals in the field of
periodontics and adhesive restorations respectively but published few of top-cited articles.
Hence, the application of this law for conducting bibliometric analysis in some disciplines
may cause inaccurate inferences. In this study, a statistically significant association was
found between the number of the most-cited articles published in a journal and the impact
factor of that journal. This finding is in accordance with the findings of some bibliometric
studies [52–55], but contrary to those of several others [54,56].
As with several “most-cited” publications in dentistry [8,53–58], this study reported
that most of the most-cited articles in dentistry originated from the United States. This
significant contribution can be attributed to a larger scientific population, active researchers,
and ample financial resources [10,17,59–61]. Additionally, to unparalleled research work,
an increased tendency among authors to cite articles originating from the US has been
observed [17,62]. It is noteworthy that approximately 47% of the most cited dentistry
articles, including the 1st and 2nd, ranked articles in this study, originated from European
institutions, despite their small population size. Importantly, a lack of multicenter studies
was noticeable, reflecting a need to escalate international collaboration.

10. Healthcare 2021, 9, 356 10 of 15
Overall, after the US, European countries, including Sweden, Belgium, Switzerland,
UK, and Denmark, have been prominent in this list of contributing authors. Additionally, to
this study, several other bibliometric analyses have reported that authors from Asia, Africa,
and the Middle East, whether being the first or the corresponding author made a negligible
contribution to what could be considered a top-cited article [17,60,63,64]. Potential reasons
might include language barriers, gaps in conducting research, and professional networking,
as well as limited information access [65]. International organizations such as the World
Health Organization [WHO] and the United Nations [UN] could play a vital role in
bolstering these health care developments.
The particular subject area of the highly cited papers fluctuates from one decade
to another. Overall, in the present study, there was a domination of articles related to
periodontology, specifically on the topic of microbiology, although other disciplines of
dentistry, including adhesive restorations and implantology, have been progressively
incorporated. A considerable portion of our analysis comprised of narrative reviews
(36%). It might be argued that this category of publication does not follow the concept of
reproducible science [66] as a systematic review does [67]. Interestingly, the findings of this
study are in opposition to this concept of being a narrative review or systematic review.
When compared to the baseline references, randomized controlled trials, a narrative review
appeared to secure higher citations than a systematic review. One possible explanation
might be that narrative reviews aim to explain the mechanisms of diseases or hypothesis
generation; hence, a systematic method to synthesize the evidence in these cases may be
irrelevant. Furthermore, as these narrative reviews are authored by the experts in the
respective specialty and supported by reputed institutions, readers tend to believe that
these articles are not overly sensitive to bias. Nevertheless, in opposition to the previous
concerns about the non-reproducibility of narrative reviews, future research is therefore
required to explain the extent to which scientific advancement is encouraged through
systematic (in comparison with narrative) reviews. Interestingly, the dental journal with
the current highest impact factor, Periodontology 2000, is focused on publishing narrative
reviews. After narrative reviews, clinical trials are the most frequently cited study design
(24%). This finding is in agreement with the results of several other bibliometric studies
conducted in other medical fields including orthopedic surgery [68], anesthesia [59], and
general surgery [60].
A distinctive characteristic of this analysis was that it included 10 evidence level-1
studies, including systematic reviews, meta-analyses, and randomized controlled trials.
These findings do not coincide with the findings of several other bibliometric analyses
performed on various specialties within dentistry and medicine [16,25,68–70]. Recently,
these high evidence level studies have been performed and are securing high citations,
despite only being published in recent years [71]. Such reports are useful for facilitating
decision-making, directing practice, and advancing research, so a high number of such
studies in the current study is not surprising and provides further proof of the maturation
of the discipline [72].
This bibliometric analysis has several limitations. First, for a given research field,
many factors may influence the citation count, including the age of the publication, journal
of publication, the reputation of author, institution, and country of origin as well as the
original language. Second, the analysis of self-citations and citations in textbooks and
lectures was not performed. Moreover, the fact that some authors may be inclined to cite
articles from a particular journal in which they intend to publish an article [73]. Third,
the analysis of the contributing countries was based on the address of the corresponding
author. A statistical bias may occur once the address of the corresponding author is
changed [74]. Furthermore, for corresponding authors working in multiple institutions, we
only considered the first institution.

11. Healthcare 2021, 9, 356 11 of 15
4. Materials and Methods
4.1. Search Strategy
A total of 91 journals included in the category “Dentistry, Oral Surgery, and Medicine”
in the database of the 2019 edition of the Journal Citation Report: Science Edition, a
section of the Clarivate Analytics (https://www.jcr.clarivate.com) (accessed on 1 January
2021) were selected. An electronic literature search on Scopus (https://www.scopus.
com) (accessed on 1 January 2021) database was performed on 1 January 2021. The
journals American Journal of Orthodontics, now called the American Journal of Orthodontics
and Dentofacial Orthopedics, the International Journal of Oral Surgery, now called as the
International Journal of Oral and Maxillofacial Surgery, and Critical Reviews in Oral Biology and
Medicine, now affiliated with the Journal of Dental Research, were also reviewed.
As the search strategy for each journal, the journal’s title was written in the source
title’ section without any restriction of language, publication year, and study design of
the article. Using the ‘documents’ tool of Scopus, the citation counts of all the articles
published in all dentistry journals were identified.
4.2. Article Selection
According to the selected database, 336,381 articles were retrieved, out of which, the
top 100 most-cited publications were further selected for this bibliometric analysis. The
top 100 most-cited articles were selected and ranked based on their citation count. After
ranking these articles, their cross-matching was performed with the citation data from
Google Scholar to evaluate any fluctuation in citation counts.
4.3. Data Extraction and Bibliometric Variables
A total of 100 articles were included in this study, and their complete text was down-
loaded. The following bibliometric variables were extracted: publication title, citation
count, current citation count (i.e., the total number of citation count collected by an article in
2020) [75], citation density (i.e., the total number of citation count/age of publication) [75],
publication year, authorship, country of origin, study design, the field of interest, evidence
level, and journal of publication.
Based on the study design, the articles were categorized as animal study, classification
or tool for assessing the results, case-control study, cohort study, consensus report, in vitro
study, letter to the editor, narrative review/expert opinion, new material or technique,
randomized controlled trial, and systematic review/meta-analysis. Based on the field
of interest, the articles were classified as adhesive restorations/dental materials, bone
morphology/histology, behavior management, dental caries, endodontics, implantology,
oral biology/morphology, oral pathology/medicine, oral radiology, orthodontics, oral
hygiene, periodontology, pediatric dentistry, pain dysfunction/orofacial pain syndrome,
regenerative dentistry, and saliva/biochemistry.
4.4. Data and Statistical Analysis
The Visualization of Similarities (VOSviewer) software (Centre for Science and Tech-
nology Studies, Leiden University, Leiden, The Netherlands) [76] was employed to visually
analyze the registers separately, drawing a network of links among prominent authors,
contributing countries, publishing journals, and author keywords to identify the strongest
link of the net. The reason for selecting this software to draw and represent large net-
works from bibliometric information among other software, including Pajek or Gephi, is
the remarkable display quality, the choice of demonstrating the density of links, and the
probability of creating overlay maps adding data batches. Moreover, this software has been
employed in several bibliometric analyses [75,77–80]. The characteristics are relevant for
performing our bibliometric analysis.
Descriptive and bivariate analyses were performed using a statistical software package,
i.e., IBM SPSS Statistics version 24.0 (IBM, Chicago, IL, USA). To assess the normality of
the data, the Shapiro-Wilk test was conducted. Mean (standard deviation) or median

12. Healthcare 2021, 9, 356 12 of 15
(interquartile range) were calculated based on normality and distribution of data. To
evaluate the median differences between the independent groups, the Kruskal–Wallis test
was performed. Post hoc testing was performed to assess the median differences within
each group. Any decrease or increase in the time-dependent trends was analyzed by
performing the Mann–Kendall trend test. The Spearman-rank test was performed to assess
the correlation between the publication count of the journal and the age of the journal. A
value of p 0.05 was considered statistically significant.
5. Conclusions
An appropriate selection of search engine and search strategy are extremely important
to conduct a thorough bibliometric analysis. In this study, changing the search database
resulted in several prominent differences when compared with the outcomes of a similar
analysis published by Feijoo et al. [9] in 2014. The current study reported that narrative
reviews/expert opinions related to periodontology having evidence level V were the
most-cited articles in dentistry.
Supplementary Materials: The following are available online at https://www.mdpi.com/2227-903
2/9/3/356/s1, Table S1: The list of the top 100 most-cited articles published in the dentistry.
Author Contributions: F.Y.A.; Conceptualization; Data curation; Formal analysis; Investigation;
Methodology; Writing—original draft. E.K.; Conceptualization; Resources; Software; Supervision;
Validation; Writing—review and editing. M.T.; Formal analysis; Methodology; Resources; Supervi-
sion; Writing—review and editing. All authors have read and agreed to the published version of the
manuscript.
Funding: The authors would like to acknowledge the financial support provided to Faris Asiri by
the Deanship of Scientific Research at King Faisal University, under Nasher’s Track 206003.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Acknowledgments: The authors would like to acknowledge the University of Western Australia and
the College of Dentistry, King Faisal University for their ongoing support.
Conflicts of Interest: The authors declare no conflict of interest.
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